OssoVR Lets Surgical Training Continue Virtually Despite COVID Limitations

Over the past few months, medical student and resident training has been severely limited due to Covid-19. However, knowledge, coordination, dexterity, and experience may not have to suffer because of quarantine and social distancing restrictions. OssoVR, a leading virtual reality surgical training and assessment platform, has been able to expand its curriculum to encompass multiple resident specialties. In an up and coming research article accepted by an orthopedics journal, a study performed by OssoVR will show about a 300% improvement in ability of participants to complete a surgical procedure without any supervision.

OssoVR has recently partnered with Johnson & Johnson, and as of April, has begun distributing Oculus Quest headsets to doctors-in-training and surgeons in the United States. The VR company hopes to obtain excellent training performance in surgeons that use its platform that will help propel its virtual technology forward, and the goal is to expand this program worldwide over time.

We spoke to Dr. Justin Barad, CEO and Co-Founder of OssoVR, and one time Medgadget editor, to find out more about what his company is up to.

Alice Ferng, Medgadget: How has Osso VR improved its platform over the past couple of months, and what have been some immediate changes made in the face of COVID?



Dr. Justin Barad, CEO and Co-Founder of OssoVR: First and foremost we have been ensuring that our customers and users are safe to use VR and educated on how to utilize the technology correctly in today’s environment. Following CDC, Oculus, and our own physician guidelines we’ve set up processes to make sure that VR training can continue to be utilized with peace of mind. We’re rolling out several new features like the ability to monitor analytics at the organizational level and the world’s largest launch on Oculus Quest in partnership with the Johnson & Johnson Institute.

We’ve also seen Osso VR move from a cool supplemental educational modality to an integral need-to-have-tool for our 20+ residency partners. Dr. Bullock at Marshall University recently sent us this feedback: “We have integrated Osso VR into our curriculum for resident rotations including trauma, pediatrics, and arthroplasty. We have been using the system for the past 2 years and feel it has become an integral part of training.”

Medgadget: What have been the largest challenges faced in scaling up your platform use? How many users did you have pre-COVID, and how many now? How quickly is it growing?

Dr. Barad: A typical surgeon will be expected to perform any of hundreds (if not thousands) of procedures on demand. This results in a huge need for a wide variety of procedures to be able to practice on at a moment’s notice. Luckily we have spent years developing a platform that allows us to rapidly develop almost any procedure in a way that’s intuitive, educational and engaging.

We’re definitely living in unprecedented times, and healthcare professionals are facing the toughest challenges. They are either on the frontlines, risking their lives, or they are staying at home, unable to train and hone their skills given that elective cases are mostly on hold. This unique situation has led to massive demand for ways to train remotely without needing to be in the hospital, and we’ve seen a 10x spike in demand from teaching hospitals.

To keep up with demand, we’ve been aggressively scaling the team with hires from Apple, Microsoft and Industrial, Light & Magic. Our team comes from not only AAA game studios but also consists of an Oscar and Emmy award winner … seriously!

Medgadget: What types of surgical training modules do you offer, and which procedures/specialties do they target? What’s in the works?

Dr. Barad: We offer modules in arthroplasty, pediatric orthopaedics, foot & ankle, orthopaedic trauma, interventional pulmonology, vascular surgery and robotics. We’ve found strong demand in the field of interventional cardiac and vascular procedures and are starting to expand more heavily into that area as well.



Medgadget: Do you offer additional accessories to both software and hardware pairings for these trainings to make things as realistic as possible?

Dr. Barad: A common misunderstanding is that realism = improved skill transfer. In fact, a very interesting study actually asked 20 surgeons this very question, and 17 responded that they felt it was the most important aspect. However, after trying a high fidelity haptic simulator, 18 out of 20 surgeons preferred the simulator with no haptic feedback at all. This is a very common response in the field of simulation and robotics. A simulator only needs to be realistic enough, something also called the minimum fidelity threshold, to lead to exponential gains in skill transfer. Realism beyond that can lead to issues including but not limited to:

• Excessive performance requirements
• Uncanny valley issues
• Usability challenges leading to user frustration (realism does not mean easy to use)

This line of thinking has led to a steady stream of simulation technologies that are too expensive (often in excess of six figures), frustrating to use, and not very accessible outside of well funded simulation centers.

Medgadget: What types of metrics and data are you using as feedback to improve virtual training? Flight path? Haptics? Averaging a person’s stats against their own?

Dr. Barad: We collect a variety of metrics and provide automated guidance to improve performance in a consistent and efficient manner.

We view early procedural learning as 3 things:

• Knowledge of steps
  • Surgery is like a symphony. If you have your part memorized, you are going to have a much smoother and higher quality performance. This is the foundation of learning any new procedure and can be overwhelming as many surgeries can have hundreds of steps. OssoVR allows for not only rapid learning and retention of steps, but allows you to granularly assess your knowledge of them.
• Accuracy
  • Knowing a step to a procedure is great, but doing it well is important too. We challenge users to perform specific steps well and give them feedback in terms of how close they were to perfect and whether their performance was acceptable, allowing for failure. These types of steps need to be specifically tailored as you don’t want them to be too easy and not educational, but you don’t want them to be frustrating either.
• Efficiency
  • Moving smoothly and efficiently through a procedure has been shown time and again to be associated with improved patient outcomes and has been a reliable foundational metric in the world of simulation.

In addition to these metrics, we collect motion data from our run throughs, and with the support the NSF are developing an artificial intelligence to assess not only proficiency, but aptitude for certain skills and procedures.

Medgadget: What are the limitations of traditional training? What about this type of virtual training?

Dr. Barad: Right now traditional training is thought of as practicing on patients or cadavers. I think it’s obvious why we probably don’t want to be practicing on unsuspecting patients, so let’s talk briefly about cadaveric training. These trainings can take place in specialized bioskills labs, hospitals, or even in hotel conference rooms The limitations of these labs are as follows:

• Expensive – They can cost $200k+ to put together
• Requires donated bodies – This can be taboo for certain cultures and regions
• Tissue consistency – Cadavers have a different consistency than living breathing humans conveying a different “feel”
• Hazardous Environment – Cadaver labs expose you to bodily fluids, sharp objects and radiation . The other day I was speaking with a colleague who suffered a deep laceration in a cadaver lab leading to permanent numbness of the forearm
• No assessment – At the end of a cadaver lab there is no objective or automated way to know if you learned what you were supposed to
• Inconsistent guidance – Cadaver labs can be an ad hoc environment. In some situations you are left independently to work through some procedure with minimal guidance or feedback – leading to a suboptimal educational experience – but in other instances such as at an industry sponsored lab you are given too much assistance, which can be overwhelming and also lead to a suboptimal educational experience
• Crowding – Given the limited supply of cadavers it is sometimes common to “group up” on cadaver stations where on person will be the surgeon while everyone else observes, leading to a significantly diminished experience for those not in the driver seat
• Limited repetitions – Cadavers can only be utilized once or twice typically, but most modern medical procedures have learning curves of 50 or more
• Travel requirement – While cadaver labs can be local, some of the bigger/higher quality ones require a multi-day trip, which for the foreseeable future may be something that is done far less frequently

The way Osso VR uses virtual reality (not all VR is created equal) solves many if not all of these issues:

• It is affordable (the Oculus Quest is $400 dollars)
• You do not need donated bodies, animals or live patients
• No exposure to hazardous fluids, radiation or sharp objects
• Automated, objective assessment of performance metrics and detailed motion analysis
• Repeatable and quality controlled guidance
• Personalized experience – no crowds to worry about (unless you want colleagues to join virtually)
• Unlimited repetitions
• No travel required – connect across continents with collaborative training

Now to answer your initial question virtual reality is an absolutely incredible, game changing technology but it certainly isn’t perfect.

Let’s talk about the controllers:

What’s exciting here is that the Oculus Quest has the ability to track your hands and fingers as a built-in feature. We are rolling this out as an experimental feature later this year, which will allow more intuitive interaction with the environment in addition to more fine motor control.

• VR controllers can be unintuitive for new users and require around a minute to onboard.
• You don’t get a sense for object weight and inertia, but you do get a great feel for tissue and bone resistance through the cutaneous haptics in the controllers.
• Some fine motor activity can be a little cumbersome with the controllers

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